Somali cattle herder Omar Hussein isn’t joining the global scramble for a COVID-19 vaccine – he’s not sure the jab will even reach his besieged town in southwestern Somalia.
The 28-year-old, who has spent much of his life living in a volatile region infiltrated by al Qaeda-linked Islamist insurgents, has bigger problems on his mind.
“I know COVID-19 is a killer, everyone knows that. It killed many in Western countries, but not here thanks to God,” the father of three told the Thomson Reuters Foundation by phone from his home in Bulo Fulay town in Somalia’s Bay region.
“Before we get the vaccine, we need other things. We need food, water, healthcare and shelter. Our people are dying because of the basics in life. We will need the vaccine when we are liberated, now we are basically under siege.”
Hussein’s name has been changed to protect his identity.
But his story holds true for millions across Africa who living in areas of armed conflict, from Somalia and South Sudan to Libya and Nigeria.
Be it more pressing priorities, a fear of “foreign” drugs or an ever-present threat of attack – obstacles abound to vaccinating people trapped in conflict zones, say charities.
Much of the continent has yet to receive any vaccine, but aid workers fear that whenever national rollouts do begin, people like Hussein could be left out.
“Vaccines should be available to everyone and your ability to receive the vaccine should not be determined by where you live or how much money you have,” said Sean Granville-Ross, Africa director for the international charity Mercy Corps.
“We have to include those most vulnerable, such as people living in conflict zones – who typically face discrimination and marginalisation and may be overlooked.”
The World Bank estimates that 2 billion people – one in four of the world’s population – live in countries where development outcomes are affected by fragility, conflict and violence (FCV).
Of the 39 countries on the World Bank’s 2021 FCV list, 21 are African. They include Burkina Faso, Cameroon, Central African Republic, Mozambique and Democratic Republic of Congo.
Risks already run higher in such settings due to cramped, overcrowded living conditions, lack of clean water or sanitation and a healthcare system worn thin by conflict, say charities. So when outbreaks do occur, they spread rapidly and widely.
Simply getting vaccines to the contested areas – many remote – is hard. Add to that the challenge of reaching millions of people who are on the move, uprooted by violence, and the scale of the innoculation problem comes into focus.
A second obstacle of any rollout: how to get there.
Far-flung at the best of times, many areas riven by fighting have also lost basic infrastructure to conflict: roads, bridges, telecoms, power – all may be weak or obliterated.
But the highest hurdle is insecurity, with health workers risking death, injury or abduction to do their job.
There were more than 1 200 attacks on health workers, medical facilities and vehicles in 20 countries in conflict in 2019, says the Safeguarding Health in Conflict Coalition (SHCC).
At least 150 health workers died, more than 500 were injured and about 90 were abducted as a result.
These included Mai-Mai militia fatally stabbing an Ebola community outreach volunteer in the DRC, an improvised explosive device in a vehicle that killed a doctor in Somalia, and a hospital raid in Cameroon by Boko Haram militants, killing four.
Aid agencies and some nations want ceasefires and safe corridors so health workers can safely vaccinate the vulnerable.
Britain’s foreign minister Dominic Raab on Wednesday told the UN Security Council that 160 million people are at risk of being excluded from coronavirus vaccinations due to conflict, including in South Sudan, Somalia and Ethiopia.
“Local ceasefires are essential to enable life-saving vaccinations to take place. And they are essential to protect the brave health workers and humanitarian workers working in incredibly challenging conditions in conflict,” Raab said.
“Ceasefires have been used to vaccinate the most vulnerable communities in the past. There is no reason we can’t do this,” he said, citing an Afghan polio vaccination programme.
Tackling misinformation, winning trust
But the challenges don’t end there, say charities.
Even if vaccines are bought, transported and delivered to war zones, convincing people to take them is another hurdle.
Due to weak governance, people living in conflict zones are more likely to be exposed to misinformation and disinformation.
Which means rumours – such as the coronavirus can only affect foreigners or that vaccine drives are a means of mass sterilisation – are rampant.
Public trust is harder to win in a conflict, where locals may face discrimination, corruption, marginalisation and neglect – often at the hands of their own government, say aid agencies.
When people link health campaigns to governments, this lack of trust can quickly thwart vaccination campaigns, they add.
“We need to recognise that trust is really lacking in many of these contexts,” said Esperanza Martinez, head of global health for the International Committee of the Red Cross (ICRC).
“Communities are mistrustful, not only of the vaccine, but what they are told because they really don’t know if they information they are getting is right.”
Aid workers say lessons can be learnt from past Ebola outbreaks in Africa where charities worked with community leaders to combat myths, and promote measures such as hand washing.
Organisations such as Mercy Corps say they trained more than 15 000 community messengers to help combat misinformation in their own villages, reaching 2.4 million people in Liberia.
Over five months, acceptance of health workers deployed in Ebola treatment units in these areas rose to 68% from 15%.
But for many people, the vaccine is simply not a priority.
In Burkina Faso’s northern town of Djibo, which is infiltrated by jihadists, some residents said the government should consider other issues first.
“The priority is to find a solution to terrorism because terrorism has killed more people than the coronavirus in Burkina,” said Boubakari Dicko, the Emir of Djibo, by phone.